You know how Sarah Palin, Chuck Grassley, et al. screamed and yelled off the top of their lungs about the evils of having Medicare pay for end-of-life planning? Oh noes, they said, paying for the elderly's end-of-life medical care planning was tantamount to "pulling the plug on grandma!" Never mind that having such a plan is the only way for grandma to legally ensure that her wishes about what sort of life sustaining care is to be provided should she become incapacitated.

So now, the Obama administration has issued new rules covering just that kind of peace of mind for the elderly, as part of the wellness visits (which are of no cost to the beneficiary) authorized by the new law. Well, Sarah Palin is not going to be happy about this...

Under the new policy, outlined in a Medicare regulation, the government will pay doctors who advise patients on options for end-of-life care, which may include advance directives to forgo aggressive life-sustaining treatment.

The rule in and of itself is pretty common sense, and quite similar to what was taken out of the health reform bill itself during the summer and fall of pure, unadulterated and uneducated screamfest.

Under the rule, doctors can provide information to patients on how to prepare an “advance directive,” stating how aggressively they wish to be treated if they are so sick that they cannot make health care decisions for themselves.

And those doctors can bill Medicare for their time. Research has shown that advanced end-of-life care planning reduces stress and anxiety for both the patient and their surviving loved ones. Not that medically peer-reviewed studies matter much to the right wing ideologues, but the Department of Health and Human Services cited the following:

The administration also cited research by Dr. Stacy M. Fischer, an assistant professor at the University of Colorado School of Medicine, who found that “end-of-life discussions between doctor and patient help ensure that one gets the care one wants.” In this sense, Dr. Fischer said, such consultations “protect patient autonomy.”

The worst part for health reform opponents? Dr. Fischer's study, appearing in the Journal of American Geriatrics Society, makes the succinct point that such planning is not only beneficial but in keeping with cherished all-American principles that Sarah Palin actually goes around proclaiming all the time. Rugged, all-America, bootstrap-pulling, mind-yo-own-bidness autonomy:

The provision to include Medicare funding for advance directive (AD) discussions between practitioners and patients roused active and, at times, vitriolic discussions on radio talk shows and social networking sites, but the concept of ADs is based on America’s core ethical principle of autonomy. Although Nancy Cruzan and Terri Schiavo brought national attention to the issue for a brief time, recent data suggest that, although only approximately 30% of adults have completed an AD, 93% of adults would like to discuss ADs with their physician. The reality is that these conversations are time consuming, incompatible with 20-minute appointments, and not billable.

How do you fill that gap between the 30% who have an end-of-life advanced directive and the 93% who would like to but don't, one of the reasons of which is that their insurance (i.e. Medicare for the most part) won't pay for it? You have Medicare pay for it.

But the regulatory structure on this is not out of the woods yet, as Congressman Earl Blumenauer, the author of the original provision that was taken out of the bill, points out, as he urged supporters not to "crow" about it.

“While we are very happy with the result, we won’t be shouting it from the rooftops because we aren’t out of the woods yet,” Mr. Blumenauer’s office said in an e-mail in early November to people working with him on the issue. “This regulation could be modified or reversed, especially if Republican leaders try to use this small provision to perpetuate the ‘death panel’ myth.”

If only keeping quiet about it would quiet the right wing nut jobs or the Congressional Republicans who are chomping at the beat to take advantage of everything. That was also before the New York Times discovered it. In an email, Blumenauer said:

The e-mail continued: “Thus far, it seems that no press or blogs have discovered it, but we will be keeping a close watch and may be calling on you if we need a rapid, targeted response. The longer this goes unnoticed, the better our chances of keeping it.”

Well, it seems that the Palins of the world will get their last screams about this, and so we in the progressive community must be ready to respond. So I'd be on the lookout for your local paper's letters to the editors, the rest of the media and any hint of the ginning up of a right wing mob over this. This is a good and needed rule, and we should be willing to go toe-to-toe with anyone to defend it.

But you see, Palin's not really against end-of-life planning; she's just against having Medicare pay for it. If you have the money to pay for it on your own, or if your private insurance will pay for it, you'd be able to plan till your heart's content in Palin's America. But if you are not lucky enough to have private insurance or the savings to pay for it on your own, well, you're on your own. In other words, in Palin's America, only those of means reserve the right to issue advanced end-of-life care directives. Yeah, I'm waiting for her tweet in 3, 2, 1...